Thursday, March 17, 2011

Kentucky Law Limits Physical Therapy Copays

Managed care companies in Kentucky often impose "specialty" copays of $50 to as high as $75 per physical therapy or occupational therapy visit. Senate Bill 112, sponsored by State Sen Tom Buford (R) and advocated for by the Kentucky Chapter, limits a copayment or coinsurance amount for a physical therapist or occupational therapist visit to no greater than the copayment or coinsurance amount charged to a patient for a physician or an osteopath for an office visit. SB 112 also requires insurers to clearly state the availability of therapies under their plans, and all related limitations.

Kentucky Chapter leadership praised the law, saying it will "lead to better outcomes as well as increased savings in the long run." Click here to read more.

Comments

Bravo for Kentucky. We in South Dakota are suffering the same issues and nobody is addressing it at all. BCBS is the culprit here, with copays 50-60$ now the norm each visit. Most cases the client pays much more than the insurance company does. APTA please help!

Posted by Josh
on 3/18/2011 6:51 PM

PT specifically contributes to primary or secondary prevention, one of the things that ObamaCare is supposed to uphold, and these outlandish co-pays completely destroy our ability to do exactly that. This needs to spread across all states.

Posted by Robert Gieringer
on 3/18/2011 6:56 PM

We have the same challenges in the West Tennessee region. The insurances with high co pay here is Cigna and Windsor Medicare. Beside the co-pay the PT will have to struggle to get authorization for approval. It takes a five to ten work day. High co-pay lead to poor compliance. Tennessee State Senators should follow like Kentucky. I would like every Tennessean to write our State Senator to take action regarding this issue.

Posted by Alexander Luy
on 3/18/2011 8:30 PM

Ditto for Florida.
BCBS limits reimbursement reimbursement to @$75 per visit then patient has $40-50 co pay. We need help also.

Posted by Bob
on 3/18/2011 8:48 PM

Hoe can we organize each state reimbursement chair to get this started nationally.

Posted by Mike
on 3/18/2011 9:03 PM

Here in North Texas Humana has plans with 100 dollar co pay for Medicare!! A two unit treatment is only reimbursed about 60 dollars by plan B. Good grief who is running Medicare?

Posted by Alan Trammell,PT
on 3/18/2011 10:18 PM

We have watched copays and deductibles skyrocket over the last few years. In fact, BCBS is the administrator for the State Employee and Teachers' Plan in this state. We have seen their copays triple and their deductibles quadruple. BCBS has some of the highest premiums, copays and deductibles. I am so glad the Obama plan will fix everything. Ha Ha.

Posted by scott
on 3/18/2011 11:10 PM

There is a insurance company in New Mexico that I am currently dealing with that has the ridiculous copay of 50$. They hold my reimbursement to $70.00, the patient has a copay of $50.00 and, presto, they are responsible for $20.00. Seems like a scam to me. In addition, they have raised the patient's premiums up by leaps and bounds. My hat is off to Kentuckys legislature for looking out for their citizens!!!

Posted by Mario diGesu
on 3/18/2011 11:24 PM

I feel all your pain, coast to coast. In Central New York State, our BCBS reimbursement is only $50. And the copay in many cases is.....$50. So the patient is paying 100% of the cost of the visit. So much for a "co" pay. More like TOTAL PAY.

Posted by Suzanne Skibinski, PT,DPT
on 3/19/2011 12:26 AM

Same issue in Pennsylvania. We need to do something about this. The high co-pay makes the patient artificially healthy reducing the expenditure from the insurance company. I had a patient who elected not to have B total knee surgery due to her $50 copay for PT. She will now live with pain and dysfunction. This is just not right!

Posted by John R. MIshock, PT, DPT, DC
on 3/19/2011 5:14 AM

united health care ( providing ins through AARP) has been reimbursing PT for less that cost ..How are we to keep our doors open?

Posted by jgomos
on 3/19/2011 6:49 AM

I like the suggestion that as a profession we stand together to get reform for our patients. What Kentucky is doing sounds great. Physician groups have a strong voice. Our voices need to be united. Our patients rely on us. I see patients choosing to go without the care they need due to high co-insurance, deductibles, and copays. In the long run it is going to cost the health care industry more money.

Posted by Melissa Mitchell
on 3/19/2011 7:23 AM

We definately need help in Florida. And quit blaming The Affordable Care Act, as you have said sarcasically, "ObamaCare"..if it didnt have to be watered down so much it could have been better. But we have yet to reign in on these horrible Medicare Advantage plans, and nothing will happen unless we get strong regulations against these for profit insurance companies that are taking the tax payers to the bank.

Posted by Patty Duffy`
on 3/19/2011 7:24 AM

Excellent job by the Kentucky chapter, and smart, too, tying it to the physicians' co-pay, since the MD's have a much stronger political voice than us and their costs are more "up front" in
insurance policies. The insurance companies can "stick" us because people do not normally question whether PT is covered when purchasing an insurance policy. It's insurance company "creep". They find a way to save money and make themselves more profitable at the expense of the PT and the patient. Many of my patients and myself, have been shocked by the amount they have had to pay out of pocket. It's a good ploy for the insurance companies, but terrible for us and the patient. The only way to address it is via legislation. I never thought I would say that. I have always been a minimalist regarding government involvement, but this issue really hits home hard!

Posted by Tom Stootsberry
on 3/19/2011 8:51 AM

With regards to all of these situations where the patient is actually paying more for the service than the insurance company is, has APTA legal department looked into whether or not these situations even meet the legal definition of an insurance plan? Seems to me that these products that are being sold as "insurance plans" would fall more into the category of "discounted services"

Posted by Randy J Case PT, DPT
on 3/19/2011 12:25 PM

We have seen co-pays shoot way up here in Connecticut--the average co-pay is $40. Patients come in for an evaluation and request "all the exercises" so that they can complete their program on their own. It's frustrating to explain to them that their doctor wants a supervised exercise program, and that some of the exercises are contraindicated at this point because of their level of pain! I even had one patient take pictures of her foot exercises with her phone so she would remember how to do them, then cancel the rest of her appointments! Connecticut needs a law like the one passed in Kentucky!

Posted by Kim
on 3/19/2011 5:42 PM

Across the nation, PTs are having similar problems and it sounds like they would like to unite in some fashion to make changes in health care. Is this a state by state change that must be made or can it be changed nationally? It is my contention that insurance companies are the only "people" making any money while their clients and health care providers suffer.

Posted by Kristie
on 3/20/2011 12:41 AM

In North Carolina, the "pushed" new BCBS plan option is for PT/OT/ST visits to have a $70 co-pay and a deductible which is double.

Posted by Geraldine Highsmith, PT, DPT
on 3/20/2011 11:39 AM

I hope all states follow Kentucky. Patients with 60.00 per visit (2 units) coverage can't get the same length of treatment as a 4 unit coverage plan. I educate my patients so they can maximize their 30 minutes. I used to treat all patents the same regardless of coverage but learned I can't pay the bills that way.

Posted by Diana C. Schonhoff, PT, DPT
on 3/20/2011 3:02 PM

Congratulations, Kentucky! Your neighbors to the north are not only dealing with higher co-pays, but us private practice owners are also competing with insurance companies allowing hospital-owned facilities the ability to "waive" co-pays, while us private practice, network participating providers, "must" collect the co-pays to maintain network status. How can I compete with that?!

Posted by Trish Strazar, PT, DPT, SCS
on 3/20/2011 9:26 PM

Bravo KY! Now, lets all get in line and follow suit!

Posted by Kay Scanlon
on 3/21/2011 10:09 AM

Way to go Kentucky. We've been battling with Blue Cross of Idaho for years in regards to capitation amounts and co-pays. For years almost all Blue Cross patients had an $800 limit per year for PT. We pushed for years to make changes and we got changes. But sometimes you have to be careful what you wish for. The new plan was $2,000 per year for speech, OT and PT combined but it had a %50 co-pay for PT. And to really make is cool the PT amount is "carved out" of their maximum out of pocket so even if they've met their max out of pocket they still have to pay the %50 co-pay for PT. Every state has their issues, and the bottom line for all of us is we all need to be involved. Not just the "cool kids:)" posting on this forum but we need to continue to get everyone on board. It's tiring, it's irritating but if we don't control our profession others will. Keep up the good fight all of you!!

Posted by Galen Danielson PT, DPT
on 3/21/2011 12:12 PM

Our patient with HUMANA, has to pay deductible, then copayment of $45/per visit and coinsurance 50% at the same time. Is this permissible by law?
Jezry Tworek PT

Posted by Jerzy Tworek -> ?LQbEI
on 3/21/2011 4:27 PM

If we could only unite as a profession and have 100 % membership in the organization that fights for us, the APTA, with its respective chapters. Imagine what we could accomplish and what a "force" we would be, all of a sudden. We could get something done on the legislative level.
Maybe we need to forward these kind of communications to the 75 % of PT's and 90 % of PTA's that are not members and obviously don't worry about these issues.....

Posted by Harry Koster, PT, Cert MDT
on 3/22/2011 11:18 AM

Yes, Kudo's to Kentucky for addressing the issue, however it hardly helps in a PT situation (per capita) as very few have a copay in outpatient care that is as exorbitant as $75. Limiting it to the same as for when they see a specialist or MD may not help all that much becuase most people will be able to afford a one time co-pay fee of $40 to see an MD but when you have to come up with that 2-3 x's a week for 3, 4 or 6 weeks that can quickly add up to $360-720+ ... Most PT's would not even pay that for their own services. Just do the exercises at home right? There needs to be a lot more restrictions on what insurances can charge for a co-pay. A $10 co-pay would be PLENTY ! and more than Fair !

Posted by David Escobar PT
on 3/22/2011 12:32 PM

Here in New York, we are lobbying for passage of a bill that requires that co-pays do not exceed 20% of the total cost of an encounter. Insurance companies are attempting to control utilization by blocking access to PT and other services. They are forcing subscribers to foot the lion's share of the cost of the "benefits" the insurance companies are claiming they provide. This has crossed over the line into false advertising. It's a ruthless and transparent ploy to continue their financial properity by climbing up onto the backs of their subscribers. They must be stopped.

Posted by Joanne Panzarella
on 3/25/2011 7:27 PM

Great move Kentucky, wish all states would do the same. I have patients who are really affected by the classification of PT as specialist on copay list.

Posted by Charles Benford PT
on 4/2/2011 11:58 PM

Kudos to our PT friends in Kentucky. As posted previously how can we initiate this legislation for all states? APTA/PPS are you listening? This is definitely going to take a village to accomplish!

Posted by Sharon Marino
on 6/16/2011 12:45 PM

Florida will try to introduce Co-payment legislation January 6th, 2012 modeled on the Kentucky victory.
Lawmakers in Florida are different than the mixed House in Kentucky. Here, an overwhelmingly conservative legislature and a Republican Governor makes a Kentucky repeat (98-0) unlikely.
We've already garnered Letters of Support from the national Arthritis Association and the Muscular Dystrophy Association.
Several Republican lawmakers have agreed to co-sponsor the bill if we can get a powerful sponsor.
Florida House Representatives are limited to 6 pieces of new legislation each annual session and sometimes House leadership picks that legislation for them. That is why broad consumer support and an industry coalition, including Occupational Therapists, may be essential.
Please contact Ti Richardson, PT if you have any questions about the Florida strategy.
The Kentucky PT association and New York PT association leaderships have been very helpful to Florida in crafting our efforts so far. I recommend reaching out to them as well.
Thank you,
Tim Richardson, PT

Posted by Tim Richardson, PT
on 8/3/2011 10:10 AM

I think KY gave it a good try, but it still isn't good enough when you need to go to physical therapy twice a week, with a $45 copay. I don't have an extra $360 a month! BCBS Anthem, you are robbing people and are useless !

Posted by Marcie Tillett
on 10/20/2011 3:17 PM

Did your law(s) address OT,Speech Therapy, Cardiac and Pulmonary Rehab? We are trying for that in WA.